Cerebral vasculitis.

Vasculitis of the cerebral arteries is rare but can occur as a primary central
nervous system (CNS) angiitis or as a manifestation of a systemic vasculitis. In these conditions,
vessel wall inflammation can lead to luminal narrowing and thromboembolism causing ischaemic
stroke (and sometimes intracerebral haemorrhage)

Reversible cerebral vasoconstriction syndrome. Reversible cerebral vasoconstriction syndrome

presents with recurrent thunderclap (abrupt onset) headaches and can cause ischaemic stroke,
intracerebral haemorrhage or focal subarachnoid haemorrhage through vasospasm and vascular
dysregulation. The precise aetiology is unknown and vasospasm might not be present on the initial
arterial imaging32. This is a separate entity to the vasospasm that occurs after aneurysmal
subarachnoid haemorrhage that can also cause ischaemic stroke

Cardiac causes of stroke Atrial fibrillation. Atrial fibrillation and flutter allow blood to stagnate,
particularly in the left atrial appendage, which can allow thrombosis and subsequent embolism to
the cerebral or systemic circulation. Both permanent and paroxysmal atrial fibrillation increase the
risk of cardioembolic ischaemic stroke33. The prevalence of atrial fibrillation is increasing with an
ageing and increasingly obese population34. Other risk factors for atrial fibrillation include chronic
hypertension, ischaemic heart disease, valvular disease, diabetes mellitus, hyperthyroidism,
excessive alcohol consumption and obstructive sleep apnoea35. The risk of ischaemic stroke in
patients with atrial fibrillation can be estimated using the CHA2DS2-VASc score, which takes into
account age, history of stroke, sex, diabetes mellitus, hypertension, heart failure and vascular
disease, and can be used to indicate patients who should be considered for prophylactic
anticoagulation36.